APPLICANT INFORMATION

COMPANY INFO

Company Name: (required)

Primary E-Mail: (required)

Company Address: (required)

Company Phone: (required)

SECONDARY PERSON FOR POINT OF CONTACT

Name: (required)

Primary E-Mail: (required)

Phone:

I certify that all the above information is true and complete to the best of my knowledge and belief. I authorize verification of this information, and release all concerned from any liability in connection therewith. I hereby apply for membership at Norcross Gun Club and Range and have read and understand the qualifications of membership, application fees, and due payment requirements. I agree to abide by the Norcross Gun Club and Range bylaws, range rules, adhere to its code of ethics, and to promote its objectives. Providing false or misleading information in this application form or failure to adhere to Norcross Gun Club and Range bylaws and code of ethics shall be grounds for denial of membership or expulsion from Norcross Gun Club and Range whenever discovered.

PAYMENT AUTHORIZATION
By initialing below, I authorize automatic recurring payments for annual membership. Should you request to cancel your membership prior to one year, you will be charged the remaining balance of months. Furthermore, I acknowledge that membership will renew automatically unless a written request to cancel is provided 60 days before the annual renewal date.